Hospice Eligibility

For a patient to qualify for the hospice benefit, there must be a medical justification. There are no absolute rules but the following are guidelines commonly used to determine hospice eligibility.

Patient Eligibility for Medicare Benefits

• Must be eligible for Medicare Part A (the hospitalization benefit)
• Two physicians, the attending physician and the hospice medical director, must certify the patient is terminally ill, with a six-month or less life expectancy if the disease takes its normal course
• The patient and/or family must be aware of the prognosis and elect palliative or comfort care, rather than active curative measures
• Patient or family (if the patient cannot do so) must give informed consent
• Care must be provided by a Medicare-certified hospice
• Hospice benefits can also be obtained through private, for-profit insurance policies
• A patient may revoke the benefit and return to regular Medicare coverage at any time without jeopardizing his/her ability to resume care financed by the Medicare Hospice Benefit in the future

Hospice is not only for those with a life-limiting illness due to a cancer diagnosis

Hospice is also available for patients meeting the above eligibility with the following diagnosis:

• Heart Disease
• Pulmonary Disease
• Dementia/Alzheimer’s
• Liver Disease
• Renal Disease

Medicare Hospice Benefit Covered Services

For patients who elect the Medicare Hospice Benefit, the following services are covered when they relate to the care of the terminal illness.

• Nursing (RN) Services
• Medical Social Work Services
• Counseling Services (bereavement, dietary, spiritual, other)
• Volunteer Services
• Administrative Services provided by Hospice’s Medical Director
• Certified Home Health Aides
• Rehabilitation Therapies
• Medical Supplies
• Durable Medical Equipment
• Oxygen
• All Diagnostic and Therapeutic Modalities
• General Inpatient Hospital Care Related to the Terminal Illness